Healthcare Provider Details

I. General information

NPI: 1598618787
Provider Name (Legal Business Name): FRONTLINE HEALTHCARE ENDOCRINOLOGY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2026
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 MARIN ST STE 120
THOUSAND OAKS CA
91360-4102
US

IV. Provider business mailing address

555 MARIN ST STE 120
THOUSAND OAKS CA
91360-4102
US

V. Phone/Fax

Practice location:
  • Phone: 805-449-1111
  • Fax:
Mailing address:
  • Phone: 805-449-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: FUNGWAH CHRIS RUIZ
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 805-449-1111